

With statins being prescribed for people with perfectly normal lab results it kind of makes you wonder if we haven’t gone a little overboard in our quest to avoid heart attacks. Clearly if you never leave your house you have almost no chance of being hit by a car, but are the side effects of being a recluse worth it.

Life insurance companies have not weighed in on this practice of preventive lipid control other than the fact that they aren’t real keen on seeing total cholesterol too low. When you take someone with normal cholesterol and add a statin regimen it isn’t too hard to drive your total cholesterol down in the low 100’s or even below 100. Studies have yet to decide whether this is really a good thing or not.

Then there’s the other three rodents in the haystack, HDL (high density lipoprotein or good cholesterol), LDL (low density lipoprotein or bad cholesterol) and triglycerides. Life insurance companies go especially bonkers when you don’t have enough HDL, even when everything else is normal. They break into a sweat when someone has a cholesterol ratio, total cholesterol/HDL, that is too high. A case I am currently shopping is at the far end of this spectrum with a completely acceptable total cholesterol of 169 and HDL of 19, making his ratio 8.8. By the book, with all insurance companies, that is a standard or worse rating.

This may be one of those areas that in spite of there not being a proven link between low HDL and heart disease when the rest of the lipid profile is well within normal range, that underwriters simply stick to their guns (written underwriting guidelines). I had a somewhat protracted battle with ING Reliastar underwriters recently over a case where the cholesterol ratio was 5.1 and they maintained, given his total cholesterol of 226 it had to be 5.0 in order to qualify for preferred rates. While we finally won that battle, it’s just a sign of how entrenched underwriters can get on certain subjects and how they don’t want to get mired down in studies that show that their one size fits all guidelines aren’t weighed down by medical reality.

So, the tossup may come down to what is acceptable to you and your doctor, weighed against what is acceptable for the cost of life insurance. There do appear to be some non medical ways to raise HDL although the conclusion is, again, that there isn’t any proven link between those results and a lowering of risk of coronary artery disease.

Bottom line. While I continue to shop this case, at least for now it appears that underwriters are choosing to err on the side of caution.